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[Surgical treatment of aortico-left ventricular communication due to infective endocarditis]
H Niinami1, A Hashimoto, S Aomi
1Department of Cardiovascular Surgery, Heart Institute of Japan, Tokyo Women's Medical College.
Insights
This case study details the successful surgical repair of a complex mycotic aortic annulus aneurysm in a patient with pre-existing rheumatic heart disease. The intervention involved valve replacement and aneurysm repair, leading to a positive outcome.
Area of Science:
- Cardiovascular Surgery
- Infective Endocarditis
- Valvular Heart Disease
Background:
- A 51-year-old female presented with a mycotic aneurysm at the aortic annulus secondary to infective endocarditis.
- The patient had a history of rheumatic fever, leading to mitral stenosis, tricuspid regurgitation, aortic stenosis, and aortic regurgitation.
Observation:
- The infective endocarditis was healed upon admission.
- The mycotic aneurysm was located at the aortic annulus, specifically involving the right coronary cusp.
- The aneurysm had a communication with the left ventricle.
Findings:
- Surgical closure of the mycotic aneurysm was achieved using a prosthetic patch with mattress sutures.
- Aortic valve replacement was performed with a 19-mm St. Jude Medical prosthesis.
- Mitral and tricuspid valve replacements were completed using 27-mm and 29-mm St. Jude Medical prostheses, respectively.
Implications:
- This case highlights a successful surgical approach for managing complex mycotic aortic aneurysms in patients with multiple pre-existing valvular pathologies.
- The described surgical technique demonstrates effective treatment for severe infective endocarditis complications involving the aortic annulus.
- The long-term positive outcome suggests the viability of prosthetic valve replacement and aneurysm repair in such challenging cases.
Abstract:
A 51-year-old woman was referred to our institute for surgical treatment from an other hospital where she was diagnosed as having a mycotic aneurysm located at the aortic annulus due to infective endocarditis. The aneurysm communicated with the left ventricle, with aortic stenosis and regurgitation, mitral stenosis and tricuspid regurgitation caused by rheumatic fever. On admission to our institute, the infective endocarditis was at the healed stage. The mycotic aneurysm was located at the aortic annulus of the right coronary cusp, and was closed using a prosthetic patch with mattress sutures. Aortic valve replacement with a 19-mm St. Jude Medical prosthesis was then performed on this patch. The mitral and tricuspid valves were also replaced with 27-mm and 29-mm St. Jude Medical prostheses, respectively. The patient is doing well 1 year after surgery.